Research Article: Crowdsourcing to expand HIV testing among men who have sex with men in China: A closed cohort stepped wedge cluster randomized controlled trial

Date Published: August 28, 2018

Publisher: Public Library of Science

Author(s): Weiming Tang, Chongyi Wei, Bolin Cao, Dan Wu, Katherine T. Li, Haidong Lu, Wei Ma, Dianmin Kang, Haochu Li, Meizhen Liao, Katie R. Mollan, Michael G. Hudgens, Chuncheng Liu, Wenting Huang, Aifeng Liu, Ye Zhang, M. Kumi Smith, Kate M. Mitchell, Jason J. Ong, Hongyun Fu, Peter Vickerman, Ligang Yang, Cheng Wang, Heping Zheng, Bin Yang, Joseph D. Tucker, Elvin H. Geng

Abstract: BackgroundHIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities.Methods and findingsAn HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2–15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19–1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50–2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79–1.26), condom use (RR = 1.00, 95% CI 0.86–1.17), or syphilis testing (RR = 0.92, 95% CI 0.70–1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation.ConclusionsIn this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC).Trial NCT02796963

Partial Text: Approximately 14 million people living with HIV have yet to be tested, compromising the effectiveness of HIV treatment and prevention programs [1]. Testing rates are particularly poor among key populations (e.g., men who have sex with men [MSM], 25%–32%) in low- and middle-income countries (LMIC) [1,2]. Entrenched community norms that marginalize key populations, limited HIV resources, and insufficient community awareness all contribute to low levels of HIV testing around the world, including China [3–5].

HIV testing is an essential first step in the HIV care continuum. Although HIV testing is a major global health priority, in key populations large numbers of people remain untested [28]. We recruited MSM from eight Chinese cities and followed individuals longitudinally for 12 months to evaluate the effect of an intervention developed through crowdsourcing on promoting HIV testing. We found that the crowdsourced intervention was effective in promoting HIV testing compared to the control period, showing an 8.9% absolute increase (and a 43% relative increase) in HIV testing during the intervention period. The intervention was particularly useful in promoting HIV self-testing. Our study extends previous research on crowdsourcing by using it to develop a comprehensive HIV testing service, evaluating its effectiveness in a pragmatic trial, and assessing the long-term effect of the intervention [17]. In contrast with our study, nearly all of the limited crowdsourcing health research studies have been observational to date [17].



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